This inspection took place on 10 and 11 May 2016 and was unannounced.

Mary Stevens Hospice is registered to provide specialist palliative care and clinical support for adults with life limiting illnesses. The service provides care on their in-patient facility which catered for up to ten people. At the time of the inspection there were six people using the service. People could also access support from specialist nurses in day hospice. The services provided included counselling and bereavement support, day hospice care, family support, chaplaincy, occupational therapy, physiotherapy and complementary therapies. The day hospice could cater for eighteen to twenty people daily some of whom had also used the inpatient facilities.

The manager was registered with us as is required by law. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe. Staff were trained and understood their responsibilities in keeping people safe from harm or abuse. They knew how to recognise and report any concerns about people’s safety. Care was centred on the needs of the individual and included the management of any risks to their health or well-being

There were clear systems in place to review and analyse accidents and incidents and take action to reduce the reoccurrence of these.

Staff were recruited safely and doctors, specialist nurses, care staff and volunteers were qualified, supported and trained to meet people’s needs. The provider had lone working arrangements to ensure staff or volunteers who worked in the community were safe. People spoke highly of the availability and skills of staff to meet their needs.

There were systems in place to safely manage and administer medicines to people. People received their medicines for pain relief or symptom management without delay. A dedicated internal pharmacy lead supported medical staff to ensure people received their medicines in a safe and timely manner.

The rights of people to make important decisions about their health or wellbeing were protected because staff followed the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People enjoyed the meals provided which catered for a range of people with specialist diets. People were supported to eat and drink and staff worked with other health professionals to promote people’s nutritional welfare.

Staff knew each person well and understood how to support them when they were unwell or approached the end of their life. People were at the heart of the service and fully involved in the planning and review of their care. This included the management of their pain and symptoms and their preferences and wishes with regard to their end of life care including their preferred place of death. People’s emotional and spiritual needs were explored and respected and people had access to complementary therapies to help manage their symptoms.

People told us staff were very caring, kind and receptive to their needs. People’s independence was encouraged and their privacy and dignity protected. Staff worked hard to provide lasting and memorable experiences for people and their family members so that they experienced compassionate care.

Leadership was strong and consistently looked at ways to promote the provision of palliative and end of life care for people. There was a clear management structure with good communication so that everyone, including the trustees, shared the same vision and plans for the future. The monitoring of the service was consistent and links with local and national organisations ensured the provider was sharing best practice.

The service was undergoing some refurbishment to change one of their three bedded wards into three separate en-suite rooms. During this change, there were seven places available for people. There were four people using the service at the time of our inspection. We spoke with one person, two relatives, eight staff members and the registered manager of the service.

People’s care plans were detailed to include information about their needs. We saw that people received person centred care. One person told us, “It is very good here, excellent really.”

Staff were aware of their duties to protect people. We found that arrangements were in place to ensure that people were protected from the risk of abuse.

Selection and recruitment processes were robust. We found that staff had the necessary checks completed before they worked at the service.

The service had robust systems in place to monitor the quality of the service. We found that improvements were made and action was taken when needed. One relative said, “We really can’t complain, they are very good.”

We spoke with the nominated individual, three nursing staff, two domestic staff, staff who worked in the day hospice providing complementary therapies, and volunteer staff. We visited the ward and the day hospice and spoke with eight people receiving a service.

People told us staff told us the hospice staff treated them with respect, were professional and helped them with many aspects of their daily lives. One person commented how staff explained everything and how they enjoyed the activities and therapies provided.

People told us they were made very comfortable and were fully involved in all decisions about their care and treatment. People told us that staff were supportive and friendly. One person said, "They tell me about the treatments available and they listen to what I want and don’t want, it makes a big difference to how you feel".

We saw the hospice was clean and well maintained. One person commented, "It is very clean, it’s comfortable and not much like a hospital setting. It’s fairly private because we have the curtains around our beds”.

We found that people had their pain relief as they needed it. One person told us, “As soon as I need a new pain relief the nurses sort it out, this is so much quicker than if I was at home”.

People told us they were confident in the abilities of all the staff.

People we spoke to were very complimentary about the home.

They told us

" The staff are very good"

"The care is very individual and personal"

"The staff are great they care for me very well"

People told us that they were very happy with the care they received and that the care was very specific to their individual needs.

People told us that staff are very approachable, helpful and caring.They told us they can have something to eat and drink when they want. They told us staff always consult them about their individual needs.